EP3541305B1 - Chirurgisches ultraschallhandstück - Google Patents

Chirurgisches ultraschallhandstück Download PDF

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Publication number
EP3541305B1
EP3541305B1 EP17809034.6A EP17809034A EP3541305B1 EP 3541305 B1 EP3541305 B1 EP 3541305B1 EP 17809034 A EP17809034 A EP 17809034A EP 3541305 B1 EP3541305 B1 EP 3541305B1
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EP
European Patent Office
Prior art keywords
housing
thermal
thermal conductive
electrical insulating
handpiece
Prior art date
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Application number
EP17809034.6A
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English (en)
French (fr)
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EP3541305A1 (de
Inventor
Daniel J. Cotter
Prakash Manandhar
Igor V. Kosenko
Saurav V. Gupta
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Integra Lifesciences Enterprises LLLP
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Integra Lifesciences NR Ireland Ltd
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Priority to EP20207021.5A priority Critical patent/EP3799810B1/de
Priority to EP23196215.0A priority patent/EP4272687A3/de
Publication of EP3541305A1 publication Critical patent/EP3541305A1/de
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Publication of EP3541305B1 publication Critical patent/EP3541305B1/de
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00831—Material properties
    • A61B2017/00929—Material properties isolating electrical current
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320069—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for ablating tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/32007—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with suction or vacuum means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320084—Irrigation sleeves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00059—Material properties
    • A61B2018/00071—Electrical conductivity
    • A61B2018/00083—Electrical conductivity low, i.e. electrically insulating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00059—Material properties
    • A61B2018/00089—Thermal conductivity
    • A61B2018/00101—Thermal conductivity low, i.e. thermally insulating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A61B2090/035—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself preventing further rotation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00—General characteristics of surgical instruments
    • A61B2217/002—Auxiliary appliance
    • A61B2217/007—Auxiliary appliance with irrigation system
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B06—GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS IN GENERAL
    • B06B—METHODS OR APPARATUS FOR GENERATING OR TRANSMITTING MECHANICAL VIBRATIONS OF INFRASONIC, SONIC, OR ULTRASONIC FREQUENCY, e.g. FOR PERFORMING MECHANICAL WORK IN GENERAL
    • B06B1/00—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency
    • B06B1/02—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy
    • B06B1/06—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy operating with piezoelectric effect or with electrostriction
    • B06B1/0607—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy operating with piezoelectric effect or with electrostriction using multiple elements
    • B06B1/0611—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy operating with piezoelectric effect or with electrostriction using multiple elements in a pile
    • B06B1/0618—Methods or apparatus for generating mechanical vibrations of infrasonic, sonic, or ultrasonic frequency making use of electrical energy operating with piezoelectric effect or with electrostriction using multiple elements in a pile of piezo- and non-piezoelectric elements, e.g. 'Tonpilz'

Definitions

  • Embodiments of the present invention relate generally to surgical handpieces, for example, handpieces in ultrasonic surgical aspirator systems for tissue ablation.
  • Ultrasonic aspiration has become the standard of care for removal of tumors and diseased tissue in neurosurgery and general surgery.
  • Ultrasonic aspirators are used for ultrasonic fragmentation of tissue at an operation site and aspiration of the tissue particles and fluid away from the site.
  • ultrasonic surgical aspirators include an ultrasonic transducer supported within a handpiece, an ultrasonically vibrating horn or tip operably connected to the ultrasonic transducer, and a sleeve or flue positioned about the horn.
  • the horn includes a longitudinally extending central bore having one end located adjacent a distal tip and a second end located adjacent the proximal end of the horn.
  • the proximal end of the horn is adapted to engage a vacuum source to facilitate aspiration of fluid.
  • the flue is positioned about the horn to define an annular passage. Irrigation fluid is supplied through the annular passage around the horn to the surgical site where it mixes with blood and tissue particles and is aspirated through the bore in the horn. By mixing the irrigation fluid with the blood and tissue particles, coagulation of the blood is slowed down and aspiration thereof is aided.
  • the longitudinally vibrating tip in such an aspirator is brought into contact with tissue, it gently, selectively, and precisely fragments and removes the tissue.
  • the handpiece typically has a housing encasing a transducer on which a surgical tip is fastened.
  • the housing is commonly made of a polymeric material for electrical safety, especially with high-voltage electrosurgery levels (e.g., 1750 Vp) applied to the metallic body of the transducer and surgical tip.
  • CUSA Excel 36kHz handpiece is described in U.S. Patent No. 6,214,017 to Stoddard, ct al.
  • 23kHz handpiccc is dcscribcd in U.S. Patent Nos. 4,425,115 and 4,223,676 to Wuchinich et al.
  • polymer housings sometimes failed due to rotation of the transducer, as a result of low-allowed stress of plastic and concentrated stress of mating metallic anti-rotation constraints.
  • the commercial CUSA Excel36 kHz handpiece is magnetostrictive and has a hex feature that can fail under misuse, such as the nurse tightening or loosening the surgical tip while only holding the internal horn with the housing. Many of the failed handpieces are twisted in the housing.
  • the transducer vibrates along its length and stepped horns and specialty profiles of reduced diameter amplify vibration. Often, the surgical tip is a single use device which must be attached under high torque (e.g.
  • the internal ultrasonic horn of the transducer commonly has flats or hex features, such as a nut, for holding the transducer while tightening the surgical tip with a special torque wrench.
  • a torque base is provided as a platform to hold the handpiece for fastening and loosening a surgical tip. It is found in practice that sometimes the nurse or clinician does not employ the torque base to hold the transducer while tightening the surgical tip before use or loosening it following the procedure.
  • Piezoelectric transducers have PZT (lead-zirconate-titanate) ceramics that are electrically connected by wires to external cables, which can break when twisted.
  • Magnetostrictive transducers depend on positioning of the transducer stack in the magnetic field to ensure adequate power. Effective anti-rotation constraints are needed, but these must not rigidly couple ultrasound during vibration to the housing, because of loss of power, errant heating, and potential for audible noise from sub-harmonics. Hex features alone on internal horns with mating hexagonal recesses on housings could fail structurally at the applied torque needed for surgical tips.
  • JP HOI 94841 A describes an ultrasonic treatment device.
  • WO 2010/057211 A1 describes systems and methods for ablating body tissue.
  • embodiments of the present invention disclose high-powered compact ultrasonic transducers with electrosurgery coagulation that incorporate a conductive thermal diffuser to eliminate objectionable hot spots from the surgeon's hands in prolonged usage, such as in brain tumor removal and liver resection.
  • a surgical handpiece comprises a housing, an electrical component within the housing, and a thermal diffuser disposed between the housing and the electrical component and comprising a thermal conductive layer and an electrical insulating layer.
  • the thermal conductive layer is closer to the housing than the electrical insulating layer.
  • the thermal conductive layer comprises a plurality of thermal conductive material pieces. There is an overlap between two thermal conductive material pieces.
  • the housing may have an elongated body and the thermal diffuser may be in a cylindrical or partially cylindrical form that fits in the elongated body around the electrical component.
  • the thermal conductive layer may be made of a material selected from the group consisting of copper, aluminum, nickel, silver, gold and alloys thereof.
  • the electrical insulating layer may be made of a material selected from the group consisting of polytetrafluoroethylene, polycarbonate, polypropylene and combinations thereof.
  • the thermal conductive layer and the electrical insulating layer may be bonded with an adhesive.
  • the housing may be made of an electrical insulating material.
  • the electrical component may be an ultrasonically powered transducer.
  • a surgical handpiece may comprise a housing having an elongated body along a longitudinal axis.
  • an ultrasonically powered transducer may be positioned within the elongated body of the housing.
  • a thermal diffuser may be disposed between the elongated body of the housing and the transducer.
  • the thermal diffuser comprises a thermal conductive layer and an electrical insulating layer.
  • the thermal conductive layer is closer to the elongated body of the housing than the electrical insulating layer.
  • the thermal diffuser may be disposed adjacent the elongated body of the housing and may be radially spaced outwardly from the transducer.
  • the thermal conductive layer comprises a plurality of thermal conductive material pieces. There is an overlap between two thermal conductive material pieces.
  • the thermal conductive layer may be made of at least copper and the electrical insulating layer may be made of at least polytetrafluoroethylene.
  • the thermal conductive layer and the electrical insulating layer may be bonded with an adhesive.
  • an ultrasonic surgical handpiece may comprise an elongated housing having an inner surface, a longitudinal axis, and/or a housing engagement portion on the inner surface.
  • the housing engagement portion may have a transverse section that includes a central recess, a plurality of pointed recesses pointing radially outward from the central recess and spaced evenly about the longitudinal axis, and/or convex arcs joining adjacent pointed recesses.
  • an ultrasonic horn may be contained coaxially within the housing and include an outer surface and a horn engagement portion on the outer surface.
  • the horn engagement portion may have a transverse section that includes a central portion, a plurality of pointed protrusions extending radially outward and spaced evenly about the longitudinal axis, and/or concave arcs joining adjacent pointed protrusions.
  • each of the pointed protrusions may correspond in shape and may be engageable with each of the pointed recesses.
  • each convex arc may have a side wall which is generally parallel with the longitudinal axis
  • each concave arc may have a side wall which is generally parallel with the longitudinal axis.
  • the housing engagement portion may comprise at least three pointed recesses
  • the horn engagement portion may comprise at least three pointed protrusions.
  • the housing engagement portion may comprise five to seven pointed recesses
  • the horn engagement portion may comprise five to seven pointed protrusions.
  • at least one pointed recess may have a recess tip portion that is rounded or curved or constitutes a portion of a sphere.
  • at least one pointed protrusion may have a protrusion tip portion that is rounded or curved or constitutes a portion of a sphere.
  • a surgical handpiece which comprises a housing, an electrical component within the housing, and a thermal diffuser disposed between the housing and the electrical component.
  • the thermal diffuser comprises a thermal conductive layer and an electrical insulating layer, wherein the thermal conductive layer is closer to the housing than the electrical insulating layer.
  • the thermal conductive layer comprises a plurality of thermal conductive material pieces, and there is an overlap between two thermal conductive material pieces.
  • the housing of the surgical handpiece has an elongated body and the thermal diffuser is in a cylindrical or partially cylindrical form that fits in the elongated body around the electrical component.
  • an anti-rotation feature is provided for distributing force of the metal horn applied to the polymer housing by increasing applied area under torque, thereby reducing failure of surgical devices due to rotation of the transducer during tightening or loosening of surgical tips.
  • an ultrasonic surgical handpiece which comprises an elongated housing having an inner surface, a longitudinal axis, and a housing engagement portion on the inner surface, the housing engagement portion having a transverse section that includes a central recess, a plurality of pointed recesses pointing radially outward from the central recess and spaced evenly about the longitudinal axis, and convex arcs joining adjacent pointed recesses; an ultrasonic horn contained coaxially within the housing and having an outer surface and a horn engagement portion on the outer surface, the horn engagement portion having a transverse section that includes a central portion, a plurality of pointed protrusions extending radially outward and spaced evenly about the longitudinal axis, and concave arcs joining adjacent pointed protrusions; and wherein each of the pointed protrusions corresponds in shape and is engageable with each of the pointed recesses.
  • each convex arc of the housing engagement portion has a side wall which is generally parallel with the longitudinal axis
  • each concave arc of the horn engagement portion has a side wall which is generally parallel with the longitudinal axis.
  • at least one pointed recess may have a recess tip portion constituting a portion of a sphere
  • at least one pointed protrusion may have a protrusion tip portion constituting a portion of a sphere.
  • distal refers to that portion of the instrument, or component thereof which is farther from the user while the term “proximal” refers to that portion of the instrument or component thereof which is closer to the user during normal use.
  • proximal refers to that portion of the instrument or component thereof which is closer to the user during normal use.
  • the terms “ultrasonic horn,” “ultrasonic tip,” “ultrasonic aspirating tip,” “ultrasonic surgical aspirating tip,” “aspirating tip,” “ultrasonic surgical tip,” “surgical tip”, “horn” and “tip” are used herein interchangeably.
  • housing housing
  • transducer housing are used herein interchangeably.
  • internal ultrasonic horn and “internal horn” are used herein interchangeably.
  • FIGS. 1-3 show an ultrasonic surgical apparatus 10 for ultrasonically fragmenting and aspirating tissue.
  • the ultrasonic surgical apparatus 10 includes a handpiece 12 for use by a surgeon to direct fragmentation.
  • the handpiece 12 encases a transducer 19 coupled to an internal ultrasonic horn 11 to which a surgical tip 14 is fastened.
  • the transducer converts electrical energy into mechanical motion.
  • the surgical tip 14 can be powered by the transducer 19 and be ultrasonically actuated to fragment tissue and suction effluent via a central channel 17.
  • the internal ultrasonic horn 11 includes a connecting point for the surgical tip 14 and transfers the vibrations from the transducer 19 to the surgical tip 14 to fragment tissue during surgery.
  • a distal end portion 13 of a surgical tip 14 extends beyond a distal end of a flue 16.
  • the internal ultrasonic horn 11 and the surgical tip 14 may be made of titanium or other conventional materials known in the art.
  • a cooling and irrigation system which provides cooling fluid to the ultrasonic horn 14 is provided for maintaining temperature within an acceptable range.
  • the handpiece 12 includes a housing 50, which may be formed of a sterilizable plastic, metal or other suitable materials or a combination thereof.
  • the flue 16 provides a path for irrigation fluid or liquid and connects to the distal end of the handpiece 12.
  • the flue 16 typically connects to the handpiece 12 via a nosecone 40.
  • the flue 16 may include or attach to a flue tube 18.
  • the nosecone 40 connects to the housing 50 and covers the proximal end portion of the surgical tip 14.
  • An irrigation tube 22 connects to the flue tube 18 up-stream and supplies irrigation fluid through the flue tube 18 to an operative site during surgery.
  • An aspiration tube 24 provides suction and a path for aspiration from the operative site to a collection canister (not shown).
  • An electrical cable 26 provides power to the apparatus or provides switching connections.
  • the handpiece 12 has an elongated housing 50 and an electrical component, such as the ultrasonically powered piezoelectric transducer 19, within the housing 50.
  • the handpiece 12 also has a thermal diffuser 100 within the housing 50.
  • the thermal diffuser 100 is disposed between the housing 50 and the electrical component 19.
  • the thermal diffuser 100 is in a cylindrical form or a substantially or partially cylindrical form that fits in the elongated body of the housing 50 around the internal electrical component 19.
  • the housing has a proximal shoulder 52 and a distal shoulder 54 on the inner surface of the housing.
  • the proximal shoulder 52 faces generally distally and the distal shoulder 54 faces generally proximally.
  • the shoulders 52, 54 are formed radially about the longitudinal axis L of the housing 50 and form a sitting space in between for the thermal diffuser 100 to snugly sit in and stay in place around the inner surface of the housing 50.
  • the housing is made of a material that is electrical insulating and preferably also heat resistant.
  • the housing may be made of polyphenylsulfone.
  • FIGS. 6 to 14 show an exemplary embodiment of a thermal diffuser of the present invention.
  • the thermal diffuser 100 is made from a thermal diffuser composite sheet 150 that comprises a thermal conductive layer 110 and an electrical insulating layer 120.
  • the thermal conductive layer 110 comprises thermal conductive material pieces 110a, 110b with overlapping areas 110c between pieces.
  • thermal diffuser take a sheet of an electrical insulating material 120, such as a sheet of polytetrafluoroethylene (PTFE), of suitable dimensions.
  • thermal conductive material pieces 110a, 110b such as copper foil tape, of suitable dimensions.
  • the thermal conductive material pieces may be of the same or different sizes.
  • the edges of the copper tape or PTFE piece are then cut so that the two layers match in size and shape to provide a thermal diffuser composite sheet 150.
  • the next steps are to make the thermal diffuser composite sheet 150 into a thermal diffuser and place it into a handpiece housing.
  • An exemplary embodiment of a housing is shown in FIG. 15 . Bend or roll the thermal diffuser composite sheet 150 by a plastic rod to form a thermal diffuser 100 in a generally cylindrical form as shown in FIG. 16 .
  • the thermal conductive layer is the outer layer of the cylinder and the electrical insulating layer is the inner layer of the cylinder.
  • the strips of overlapping areas 110c extend longitudinally on the thermal diffuser.
  • use a heat gun and a plastic rod to smooth the thermal diffuser inside of the transducer housing.
  • the thermal diffuser cylinder tends to spring out in the housing and stays in place in the housing, for example, in the space between the shoulders 52, 54. Once put in the housing, the thermal diffuser cylinder opens, conform to the inner surface of the housing, and stays in place with the ends touching or nearly touching with a small gap 130, as illustrated in FIG. 18 .
  • the thermal conductive layer 110 within the handpiece is closer to the housing 50 than the electrical insulating layer 120.
  • the thermal conductive layer 110 faces the housing 50 and the electrical insulating layer 120 faces the electrical component 19.
  • the embodiment shown in the drawings has a thermal conductive layer that comprises three thermal conductive materials pieces, it is understood that the thermal conductive layer comprises a plurality of thermal conductive material pieces. There may be any suitable amount of overlap between thermal conductive material pieces, and there may be gaps between thermal conductive material pieces.
  • the electrical insulating layer may comprise or consist of a single sheet of electrical insulating material as illustrated in the drawings or a plurality of electrical insulating material pieces, and there may be any suitable amount of overlap between the electrical insulating material pieces or no overlap at all and there may be gaps between the electrical insulating material pieces.
  • the thermal conductive layer and the electrical insulating layer do not need to be perfectly continuous layers to perform their respective functions. However, it is believed the embodiment as shown, which includes three thermal conductive material pieces with overlapping areas between the pieces, will prevent deformation that may be caused by thermal expansion.
  • the thermal conductive layer is made of a material that exhibits high thermal conductivity, such as metals, carbons such as graphite, ceramics and certain composites. Materials of high thermal conductivity are widely used in heat sink applications.
  • the thermal conductive material of the thermal conductive layer preferably has a thermal conductivity value that is higher than about 90 W/m ⁇ K and more preferably higher than about 200 W/m ⁇ K. Examples of thermal conductive materials include copper, aluminum, nickel, silver, gold and alloys thereof such as aluminum alloy.
  • the electrical insulating layer is made of an electrical insulating material.
  • Electrical insulating materials are typically considered to be materials with a surface resistivity greater than 10 12 ⁇ /sq (ohms per square). Material like glass, porcelain, paper, polymeric materials such as rubber, rubber-like polymers and plastics, and composite materials are good electrical insulators. Examples of electrical insulting materials include polytetrafluoroethylene (PTFE), polycarbonate, polypropylene, polyetherimide, polyphenylsulfone, and combinations thereof.
  • PTFE polytetrafluoroethylene
  • the thermal conductive layer and the electrical insulating layer may be bonded with an adhesive or be connected by mechanical means or other means known in the art. If metal tape such as copper tape is used as the thermal conductive layer, no separate adhesive is necessary to bond it with the electrical insulating layer, as the copper tape is backed with an adhesive that may electrically conductive or non-conductive. It is also contemplated that the thermal conductive layer and the electrical insulating layer do not need to be bonded or connected by any adhesive or particular means. The layers may stay in contact after they are rolled up and inserted into the housing.
  • Suitable adhesives include, but are not limited to, acrylic, epoxy, aramid-based, urethane-based, polyamide-based, polyethylene-based, ethylene-vinyl acetate (EVA)-based, polyester-based, and polyvinyl chloride (PVC)-based adhesives.
  • the layers may also be bonded with an adhesive tape, such as a double-sided adhesive tape.
  • the exemplary embodiment of the thermal diffuser described above is a PTFE plus copper thermal diffuser. Copper tape with an adhesive side is used as the thermal conductive layer. The copper tape is backed with a PTFE polymer sheet. The copper is placed on the PTFE sheet and kept between the housing and PTFE sheet. The PTFE sheet prevents the copper from contacting and electrically shorting any of the elements of the transducer stack, such as the terminal. Additionally, PTFE has low coefficient of friction if any elements of the vibrating stack contact this material, although such contact is avoided by design.
  • the thermal diffuser can be made from a PTFE sheet having a thickness of about 0.020 inches (0.51 mm), and a copper foil tape that has a nonconductive adhesive backing and a total thickness of about 0.0029 inches (0.0074 mm).
  • the thermal conductive layer, the electrical insulating layer, and the thermal diffuser composite sheet formed from the two layers may have any appropriate thicknesses as can be readily determined by those skilled in the art, taking into consideration a number of factors including, but not limited to, the desired thermal conductive and electrical insulating properties, the available space in the handpiece housing to accommodate the thermal diffuser, and the necessary flexibility of the thermal diffuser composite sheet to be rolled up to form a generally or substantially cylindrical form or any other desired form.
  • the thermal conductive layer may have a thickness of less than about 0.1 inches (3 mm) and preferably less than 0.05 inches (1.3 mm), for example, in the range of from 0.001 to 0.010 inches (0.03 to 0.25 mm), and the electrical insulating layer may have a thickness of less than about 0.1 inches (3 mm) and preferably less than about 0.05 inches (1.3 mm), for example, in the range of 0.01 to 0.05 inches (0.3 to 1.3 mm).
  • thermal diffuser composite sheet and the thermal diffuser formed therefrom can also be readily determined by those skilled in the art, depending on a number of factors, such as the size and shape of the medical device that contain the thermal diffuser and the desired thermal diffusing effects.
  • the thermal conductive layer and the electrical insulating layer in a thermal diffuser do not need to match perfectly in size or shape so long as they overlap and provide adequate thermal dissipation and prevent short circuiting.
  • thermal diffuser would be touching the inner surface of the handpiece housing once the thermal diffuser cylinder springs out, it is believe that the thermal diffuser would work without contact with the housing or the transducer.
  • the thermal diffuser may be bonded to the housing and/or the transducer, but it is not necessary.
  • thermal conductive layer and the electrical insulating may be placed into the housing separately or sequentially.
  • a thermal conductive cylinder may be inserted into the housing and positioned in place first, and then an electrical insulating cylinder is inserted into the thermal conductive sleeve formed in the housing.
  • the thermal diffuser may have multiple thermal conductive layers and multiple electrical insulating layers arranged in any suitable order.
  • the ends of the thermal diffuser may be in contact or not in contact or may overlap to various degrees.
  • the ends of the thermal diffuser may be in contact or not in contact or may overlap to various degrees.
  • the loose end of the thermal diffuser may be bonded to the cylindrical body with an adhesive or by mechanical or chemical means, but it is not necessary.
  • the copper is not a simple heat sink, as it is not contacting the thermally heated elements, such as the terminals, or conducting.
  • Different thickness layers of copper were tested, but it was learned that a single 76 micrometer or 0.003 inch (0.0762 mm) thick sheet with minimal overlap was sufficient. Doubling the thickness had little effect on temperature at the housing, whereas heat sink size and volume in conventional electrical designs, such as for transistor and power supplies, are surface area and volume dependent and have influence on dissipation of heat.
  • the copper which is thermally conductive, diffuses radiant and convective heat from the hot spots of the transducer stack which transits the space between the transducer stack or terminal and the PTFE sheet to the copper.
  • the concentrated radiant and convective heat would attempt to concentrate at the copper, but it is highly thermally conductive so the heat diffuses about the copper. If the heat were in the form of an electric field or conducted current it would diffuse to form an equipotential surface about the whole surface of the copper. An analogy is that the copper diffuses the heat in a way that would be an equipotential temperature. However, some heat is lost to the surroundings, and some heat still conducts to the housing.
  • the copper sheet is a highly thermally conductive diffuser of concentrated convective and radiant heat arriving to its surface, thereby reducing the temperature associate with hot spots.
  • the benefit of the thermal diffuser is maintained at very high strokes for a handpiece and surgical tip combination, as exhibited with the electromechanical data and associated infrared thermal images at 5 minutes and 10 minutes of operation. High stroke and surgical tip and associated stack velocity at ultrasonic frequency are necessary to efficacy in tumor and tenacious tissue removal in neurosurgery and general surgery applications.
  • the functionality of the thermal diffuser was also maintained at rated life use ratings, and as shown in the electromechanical data for a transducer tested to two twice life ratings. The transducer is a couple degrees above body temperature at twice rated life, although the stroke has increased marginally from initial calibration. The temperature at the case is more uniform and asymptotes with time, and is less objectionable to the acute tactile sensitivity of the surgeon. Some test data are shown in FIG. 19 .
  • the thermal diffuser can lower objectionable hot spots of over 55°C to less than 41°C, and in most cases to about body temperature (37°C), such that they are not felt by the surgeon.
  • additional means may be taken to help reduce hot spots, for example, by eliminating interfaces that could cause heating under vibration of the stack. This may include removing any rigid epoxy from vibrating terminals. These terminals contact metallized electrodes on the piezoelectric ceramic disks. The terminals are vibrating at the high velocities associated with ultrasonic vibration and they are also thermally conductive, bringing the heat in the stack closer to the housing. Damping compounds that are rubber or rubber like may be placed on the terminals where they are soldered to flexible hook-up wires. Other means for reducing hot spots include using plasma metal coatings of minimal thickness, e.g. less than 25.4 micrometers of 0.001 inch.
  • the ultrasonic surgical handpiece 12 comprises an elongated housing 50 having an inner surface 550, a longitudinal axis L, and a housing engagement portion 500 on the inner surface 550.
  • the housing engagement portion 500 has a transverse section that includes a central recess 540, six pointed recesses 510 pointing radially outward from the central recess and spaced evenly about the longitudinal axis L, and convex arcs 520 joining adjacent pointed recesses 510.
  • the ultrasonic surgical handpiece 12 also comprises an internal ultrasonic horn 11 contained coaxially within the housing 50 and having an outer surface 450 and a horn engagement portion 400 on the outer surface 450.
  • the horn engagement portion 400 has a transverse section that includes a central portion 440, six pointed protrusions 410 extending radially outward and spaced evenly about the longitudinal axis L, and concave arcs 420 joining adjacent pointed protrusions 410.
  • Each of the pointed protrusions 410 corresponds in shape and size and is engageable with each of the pointed recesses 510.
  • Each convex arc 520 has a side wall 530 which is parallel with the longitudinal axis L
  • each concave arc 420 has a side wall 430 which is parallel with the longitudinal axis L.
  • each convex arc is a section of a circle or some other curved shape, such as an ellipse.
  • each convex arc may be an arc of a circle having a radius in the range of about 0.05 to about 1.0 inch (about 1.3 to about 25 mm) and preferably in the range of about 0.1 to about 0.5 inches (about 2.5 to about 13 mm).
  • each convex arc has a radius of about 0.2 inches (5 mm). It is possible that the diameter or radius measurements of the plurality of convex arcs are not identical.
  • each concave arc is a section of a circle or some other curved shape, such as an ellipse.
  • each concave arc may be an arc of a circle having a radius in the range of about 0.05 to about 1.0 inch (about 1.3 to about 25 mm) and preferably in the range of about 0.1 to about 0.5 inches (about 2.5 to about 13 mm).
  • each convex arc has a radius of about 0.2 inches (5 mm). It is possible that the diameter or radius measurements of the plurality of convex arcs are not identical, so long as the concave arcs correspond to and are engageable with the corresponding convex arcs.
  • At least one of the pointed recesses may have a recess tip portion that is rounded or curved or constitutes a portion of a sphere.
  • the recess tip portion may have a radius in the range of about 0.005 to about 0.1 inches (about 0.13 to about 2.5 mm), for example, about 0.01 inches (0.25 mm).
  • At least one of the pointed protrusions may have a protrusion tip portion that is rounded or curved or constitutes a portion of a sphere.
  • the protrusion tip portion may have a radius in the range of about 0.005 to about 0.1 inches (about 0.13 to about 2.5 mm), for example, about 0.01 inches (0.25 mm).
  • the housing engagement portion may comprise a plurality of pointed recesses, for example, at least 3 and preferably 5-7 pointed recesses
  • the horn engagement portion may comprise a plurality of pointed protrusions, for example, at least 3 or preferably 5-7 pointed protrusions.
  • the exemplary embodiment shown in the drawings has six pointed recesses in the cross-section of the housing engagement portion, and six pointed protrusions in the horn engagement portion.
  • the horn engagement portion that has six pointed protrusions is referred to hereinafter as a "hexacog".
  • the hexacog design can be used for effective anti-rotation constraints. Unlike a hex nut, which can appear like an inclined plane with mechanical advantage in rotation, a cog presents a large surface area that resists rotation while distributing load and resultant stress. Inclined planes provide mechanical advantage for lifting the hex surface away from the mating feature or surface, causing cam-out.
  • the mechanical advantage of an inclined plane is intuitive and employed in the earliest of human mechanisms, such as for lifting blocks of pyramids, zippers, and other simple but elegant mechanical systems.
  • Design of a metal to polymer interface should consider increasing area under greater loading such that the resistance to applied torque distributes and maintains stress under allowed limits.
  • the stress in a simple hex is great, and increases with the mechanical advantage of the inclined plan of the hex, such that the area is reduced as load is applied.
  • Polymers are forgiving relative to brittle materials in that local plastic deformation can occur conforming the polymer to the metal, rather than cracking under localized stress distribution.
  • the 6 cog features cam-into the polymer, the load is distributed and the area opposing the applied torque becomes greater. The applied area divides the holding force by 6, and causes less stress concentration.
  • the material must fail for the mechanism to fail.
  • the hexacog overcomes a failure mode of prior art handpieces, based on the cog railway anti-rotation mechanism. Known machining methods make the horn and housing mating geometries practical. The hexacog design was developed based on a fundamental understanding of the need to increase load distribution during elastic and local plastic deformation.
  • the hexacog of the internal ultrasonic horn When the load due to tightening the surgical tip to the internal ultrasonic horn is removed, as it is in operation, the hexacog of the internal ultrasonic horn is free to vibrate or slide longitudinally and has only casual contact with the housing.
  • the hexacog feature of the internal horn is also located close to a node, of minimum vibration, in the standing wave of the ultrasound.
  • the hexacog prevents rotation of the transducer in the polymer housing.
  • the hexacog is machined in a high cyclic fatigue life 6AL 4V titanium material and the mating polymer is polyphenylsulfone (PPSU). It is understood by those skilled in the art that other electrically insulating polymers, such as polyetherimide plastic, can be utilized.
  • the hexacog can be implemented for any ultrasonics frequency transducer, such as 23 kHz, 36 kHz, or 55 kHz transducer.
  • a reference to "A and/or B", when used in conjunction with open-ended language such as “comprising” can refer, in one embodiment, to A only (optionally including elements other than B); in another embodiment, to B only (optionally including elements other than A); in yet another embodiment, to both A and B (optionally including other elements); etc.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Public Health (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Dentistry (AREA)
  • Mechanical Engineering (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Pathology (AREA)
  • Surgical Instruments (AREA)

Claims (8)

  1. Chirurgisches Handstück, das Folgendes umfasst:
    ein Gehäuse (50);
    eine elektrische Komponente (19) innerhalb des Gehäuses (50); und
    einen Wärmediffusor (100), der zwischen dem Gehäuse (50) und der elektrischen Komponente (19) angeordnet ist und eine Wärmeleitschicht (110) und eine elektrische Isolierschicht (120) umfasst, wobei die Wärmeleitschicht (110) näher an dem Gehäuse (50) ist als die elektrische Isolierschicht (120); und
    dadurch gekennzeichnet, dass:
    die Wärmeleitschicht (110) mehrere Wärmeleitmaterialstücke (110a, 110b) umfasst, wobei zwischen zwei Wärmeleitmaterialstücken (110a, 110b) eine Überlappung besteht.
  2. Chirurgisches Handstück nach Anspruch 1, wobei das Gehäuse einen länglichen Körper aufweist und der Wärmediffusor in einer zylindrischen oder teilweise zylindrischen Form vorliegt, die in den länglichen Körper um die elektrische Komponente herum passt.
  3. Chirurgisches Handstück nach einem der Ansprüche 1-2, wobei die Wärmeleitschicht aus einem Material hergestellt ist, das aus der Gruppe ausgewählt ist, die aus Kupfer, Aluminium, Nickel, Silber, Gold und Legierungen davon besteht.
  4. Chirurgisches Handstück nach einem der Ansprüche 1-3, wobei die elektrische Isolierschicht aus einem Material hergestellt ist, das aus der Gruppe ausgewählt ist, die aus Polytetrafluorethylen, Polycarbonat, Polypropylen und Kombinationen davon besteht.
  5. Chirurgisches Handstück nach einem der Ansprüche 1-4, wobei die Wärmeleitschicht und die elektrische Isolierschicht mit einem Klebstoff verbunden sind.
  6. Chirurgisches Handstück nach einem der Ansprüche 1-5, wobei das Gehäuse aus einem elektrischen Isoliermaterial hergestellt ist.
  7. Chirurgisches Handstück nach einem der Ansprüche 1-6, wobei die elektrische Komponente ein mit Ultraschall betriebener Wandler ist.
  8. Chirurgisches Handstück nach Anspruch 7, wobei:
    das Gehäuse einen länglichen Körper entlang einer Längsachse aufweist; und
    wobei der Wärmediffusor angrenzend zu dem länglichen Körper des Gehäuses angeordnet ist und radial nach außen von dem Wandler beabstandet ist.
EP17809034.6A 2016-11-16 2017-11-15 Chirurgisches ultraschallhandstück Active EP3541305B1 (de)

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PCT/IB2017/057145 WO2018092043A1 (en) 2016-11-16 2017-11-15 Ultrasonic surgical handpiece

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EP3799810A1 (de) 2021-04-07
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US20220211407A1 (en) 2022-07-07
EP3799810B1 (de) 2024-01-24
CN113995475B (zh) 2024-07-19
AU2023203883A1 (en) 2023-07-13
AU2023203883B2 (en) 2024-07-25
JP7274621B2 (ja) 2023-05-16
CN109982654B (zh) 2021-09-03
AU2017362062A1 (en) 2019-04-11
WO2018092043A1 (en) 2018-05-24
CN113995475A (zh) 2022-02-01
EP4272687A3 (de) 2024-01-10
JP7030789B2 (ja) 2022-03-07
JP2019537455A (ja) 2019-12-26
US20180132885A1 (en) 2018-05-17
ES2846351T3 (es) 2021-07-28
AU2017362062B2 (en) 2023-03-23
JP2022044736A (ja) 2022-03-17
US11284915B2 (en) 2022-03-29
EP4272687A2 (de) 2023-11-08
CN109982654A (zh) 2019-07-05

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